Lymphatic Congestion

by Tyler Cymet, DO, FACOFP

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    00:01 Chronic lymphatic congestion will result in poor oxygenation and it’s just a poor sense of well-being.

    00:08 It increases the risk of infection, could increase mortality, may increase healing time in that when you have congestion and swelling, the tissue isn’t bathed in healthy tissue.

    00:20 You’re not getting a replenishment of the fluids and it’s just not a healthy situation.

    00:26 It can cause increased fibrosis and scarring when you don’t have a return of lymphatic fluids into the circulation and a good flow.

    00:33 And it could decrease the effectiveness of medications because you don’t get the medication getting to the area where it’s needed.

    00:40 You don’t want the medication to stay in the circulatory system.

    00:45 You want it to get out into the tissues.

    00:49 So, let me go back to the case. We have a 3-year-old male who is brought to the office by his mom with difficulty breathing, wheezing for 3 hours.

    00:57 What are the sympathetic and parasympathetic reasons that the lung is becoming inflamed and what’s going on here? Well, we know that the sympathetic system is having an effect.

    01:08 It’s causing mucosal irritation and it could lead to infection or worsening of infection, or decreased ability to fight off infection.

    01:19 It tells you which areas are more prone to having problems.

    01:24 If you have a prolonged sympathetic tone, you can have vasoconstriction that’s going to lead to hypoprofusion in the lung.

    01:31 And prolonged sympathetictonia can lead to epithelial hyperplasia and swelling because you’re not having good return and good fluid flow.

    01:40 Hypersympathetic effects lead to bronchodilation which is meant to be a protective mechanism.

    01:47 And vasoconstriction and tissue congestion will decrease oxygenation of lung tissues.

    01:53 On the parasympathetic side, the alveoli are going to fill with fluid and that’s the Hering-Breuer reflex mechanism.

    02:01 And you can’t distinguish within the lung whether it’s air or fluid there which is going to impede oxygenation of the body.

    02:08 The vagus nerve is what’s going to let the respiratory center know that the excursion is not going well, and when you need more air.

    02:17 And that becomes a sense of discomfort in the body.

    02:21 Concurrently, the carotid bodies are telling the body what needs to be done so you have more oxygenation, optimal oxygenation.

    02:28 And it is going to affect diaphragmatic functioning as well, particularly the diaphragmatic breathing rate.

    02:35 And the parasympathetic can lead to shallow, rapid respirations.

    02:43 So when you are treating somebody with a pulmonary problem, even though it’s pulmonary initially, there are a lot of effects that you can have a positive effect on.

    02:54 You can start treating the muscles and the viscerosomatic findings that you have is that breathing becomes easier.

    03:03 And there are techniques that are better tolerated and work better because somebody who is having difficulty breathing is not going to want to lie down flat.

    03:11 Their survival mechanism is saying sit up straight, lean forward, work those accessory muscles to help out.

    03:19 It’s going to stress and strain the accessory muscles but it’s also going to put the person in a position where they feel that they are functioning better.

    03:29 So you want to avoid techniques that put them in an uncomfortable situation.

    03:35 There are also techniques that will address the hypersympathetic tone and will help balance that so the patient can get to a system of ease and functioning.

    03:44 And you want to know which techniques you can do comfortably to help with lymphatic flow.

    03:49 Your goal is to increase venous and lymphatic flow, improve the arterial supply to the lungs, and ease the spasm that is going on in the lung because the secretions tend to be a spiral downward that decrease the area of oxygenation in the lungs.

    04:04 And the phlegm is not always helpful.

    04:07 While it may block or give an area of a biofilm to fight off infection, it doesn’t allow for air exchange.

    04:16 So you want to do what you can to decrease the workload of breathing and ease the efficiency of oxygen exchange.

    04:22 The OMT that you’re doing, again, I like to do it in a seated position because that’s where people are comfortable.

    04:27 I want to work on thoracic compliance and balance sympathetic tone.

    04:31 You may want to work on myofascial release techniques.

    04:36 Muscle energy is also good.

    04:37 Strain, counterstrain is another technique that is well tolerated.

    04:42 And you want to make sure that you are working on easing the muscles of respiration and allowing the thoracic spine, thorax, and the ribs to work in tandem.

    04:54 Another very common treatment done on people who are having trouble breathing is rib raising.

    04:59 That is usually early in the cycle and when people start to have an attack, or when you have no other options available to you.

    05:07 On somebody who’s in extremis, you can lay them down, if they will tolerate that, and do rib raising to help with the expansion of the thorax and exchange of air.

    05:17 When you want to do OMT to address parasympathetic innervation, you want to start in the suboccipital area with the suboccipital release.

    05:25 It’s an area where you tend to have congestion and an acute problem can become chronic.

    05:32 OA decompression is a good thing to do.

    05:35 And myofascial treatment to the upper cervical region is also helpful.

    05:39 Balance ligamentous tension is another treatment that can be helpful particularly in the upper cervical area.

    05:48 If you want to help lymphatic return, doming of the diaphragm is something that is commonly done where you have the patient lay down and you are able to palpate the diaphragm.

    05:59 You find the area of the diaphragms where they are having restrictions and you just try and help find the area of dis-ease and enhance the motion.

    06:08 I hope you find this helpful in thinking about health and illness in patients and where you can make a difference when a patient’s having issues, both minor and severe.

    06:20 Because in the osteopathic concept of the body being a single unit, the fascia and lymphatic systems are critical concepts in how this happens and what you need to do to help a patient stay healthy.

    06:33 Thank you.

    About the Lecture

    The lecture Lymphatic Congestion by Tyler Cymet, DO, FACOFP is from the course Introduction to Osteopathic Treatment.

    Included Quiz Questions

    1. Myofascial release
    2. Rib raising (seated or supine)
    3. Muscle energy to the clavicles and ribs
    4. Articulatory techniques to the thoracic spine and ribs
    5. OA decompression
    1. Suboccipital release
    2. Balanced ligamentous tension (BLT) to upper cervical spine
    3. Myofascial treatments to upper cervical region
    4. Muscle energy to thoracic and lumbar spine
    5. Articulatory techniques to thoracic and lumbar spine

    Author of lecture Lymphatic Congestion

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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